The potential for errors to compromise patient safety is especially high in oncology where chemotherapy medications with narrow therapeutic indices are used. Chemotherapy medication processes can be quite complex due to the need for multiple checks and balances to prevent errors from reaching patients. Aim 1: In a formal risk analysis project using Failure Mode and Effects Analysis or FMEA, the risks associated with each step of a complex chemotherapy medications process will be evaluated and documented for possible failure points before and after testing of a commercially available highly integrated CPOE system at a leading children's cancer center. Aim 2: Approaches to eliminate identified risks will be evaluated and tested. Medication safety is a particularly high-risk area of patient safety and the effects of a medication error with cancer chemotherapy can be devastating. According to the Institute of Medicine, over 7,000 people die each year from medical errors across the U.S. Because a large proportion of medical errors originate with the physician's written order, several groups advocate the use of computerized physician order entry or CPOE as a possible strategy to decrease the incidence of these errors. The few studies that have been conducted to determine if CPOE actually reduces medical errors have been too small to detect differences in adverse event rates and have mostly evaluated computer systems developed in-house. In addition, relatively few hospitals have invested in CPOE. A recent review of CPOE and clinical decision support systems' effects on reducing medical error rates suggested that more research was needed especially where commercially available CPOE systems were being implemented. Before implementing CPOE systems in complex treatment areas such as pediatric oncology, all aspects of the medications process require careful analysis to ensure that the risk of error actually will be reduced. Introduction of CPOE may insert a lack of familiarity that can increase risk, in and of itself, if not adequately assessed, planned for, and effectively mitigated. Physicians, nurses, pharmacists, quality improvement specialists, and reengineering specialists will utilize FMEA to evaluate each step of the chemo meds process based on the severity of the failure, likely frequency of the failure, and likelihood that the failure would be detected. The redesigned process with CPOE will be tested by using simulation testing in a developmental software environment. The final process will serve as a model for chemotherapy CPOE especially applicable to hospitals implementing integrated systems.